The first 1,000 liver transplantations in IKEM


Authors: P. Trunečka 1;  J. Froněk 2;  L. Janoušek 2;  M. Oliverius 2;  M. Kučera 2;  E. Kieslichová 3;  M. Ročeň 3;  J. Špičák 3;  J. Šperl 3;  H. Gottfriedová 3;  S. Fraňková 3;  P. Drastich 3;  I. Hejlová 3;  E. Pokorná 4;  E. Honsová 5;  J. Peregrin 6;  V. Lánská 7;  D. Hačkajlo 7;  L. Janečková 3;  A. Herman 8
Authors‘ workplace: Transplantcentrum, IKEM, Praha 1;  Klinika transplantační chirurgie, IKEM, Praha 2;  Klinika anesteziologie, resuscitace a intenzivní péče, IKEM, Praha 3;  Klinika hepatogastroenterologie, IKEM, Praha 4;  Pracoviště klinické a transplantační patologie, IKEM, Praha 5;  Oddělení odběrů orgánů a transplantačních databází, IKEM, Praha 6;  Základna diagnostické a intervenční radiologie, IKEM, Praha 7;  Oddělení lékařské statistiky, IKEM, Praha 8
Published in: Gastroent Hepatol 2013; 67(5): 399-406
Category: Hepatology: Original Article

Overview

One thousand orthotopic liver transplantations (LTx) were performed in the Transplant Centre of the Institute of Clinical and Experimental Medicine in Prague in 950 transplant recipients, 559 men and 391 females, aged 0.4–74 years during the period between April 2, 1995 and August 13, 2013. At the beginning of the programme, the average age of the recipients was 41, and 48.8 in 2012 (including child recipients). At the beginning, the average MELD/PELD score was 18.5, and this decreased to 16.3 in 2012. During the same period the mean waiting time of the listed patients increased from 42.3 to 164.9 days. Out of the total, 28 LTx were performed simultaneously with a kidney transplantation, and two with a pancreatic islets transplantation. The most frequent chronic liver disease in the patients listed for the first LTx was alcoholic liver cirrhosis in 25.4% recipients, hepatitis C cirrhosis in 13.5%, and primary sclerosing cholangitis in 11% of patients. An acute form of Wilson’s disease in 37% and a fulminant course of hepatitis B in 18.5% of patients were the most prevalent indications among the urgently listed patients. Initial immunosuppression was provided based on various combinations; the main medicine being calcineurine inhibitors (99.5%) of which Cyclosporin A was used in 266 and Tacrolimus in 729 recipients. One-year survival of recipients (Kaplan-Meier method) was 89.8%, five-year 83.1%, 10-year 75.5%, and 15-year 65.2%, and the graft survival was 86.6%, 79.4%, 71.0%, and 60.2 % respectively. The best patient and graft survival rate was achieved in patients transplanted for biliary cirrhosis and was significantly better than in any other indication group (p < 0.027). The main cause of mortality among transplant recipients during the first post-transplant year (89 cases) was sepsis (20 patients) and de novo tumours in the following years (104 cases). Liver transplantation is a very effective life-saving method with a remarkable long-term survival probability which returns many liver transplant recipients to full activity in their physical and social lives.

Key words:
immunosuppression – indication – survival – liver transplantation

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
9. 9. 2013

Accepted:
7. 10. 2013


Sources

1. Brown RS Jr. Live donors in liver ­transplantation. Gastroenterology 2008; 134(6): 1802–1813.

2. Kamath PS, Wiesner RH, Malinchoc M et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001; 33(2): 464–470.

3. Adam R, Karam V, Delvart V et al. Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR). J Hepatol 2012; 57(3): 675–688.

4. Mazzaferro V, Regalia E, Doci R et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996; 334(11): 693–699.

5. Yao FY, Ferrell L, Bass NM et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 2001; 33(6): 1394–1403.

6. Trunečka P, Boillot O, Seehofer D et al. Once-daily prolonged-release tacrolimus (ADVAGRAF) versus twice-daily tacrolimus (PROGRAF) in liver transplantation. Am J Transplant 2010; 10(10): 2313–2323.

7. Boillot O, Mayer DA, Boudjema K et al. Corticosteroid-free immunosuppression with tacrolimus following induction with daclizumab: a large randomized clinical study. Liver Transpl 2005; 11(1): 61–67.

8. Neumann U, Samuel D, Trunečka P et al. A randomized multicenter study comparing a tacrolimus-based protocol with and without steroids in HCV-positive liver allograft recipients. J Transplant 2012; doi: 10.1155/2012/894215.

9. Rowe IA, Webb K, Gunson BK et al. The impact of disease recurrence on graft survival following liver transplantation: a single centre experience. Transpl Int 2008; 21(5): 459–465.

10. Gedaly R, McHugh PP, Johnston TD et al. Predictors of relapse to alcohol and illicit drugs after liver transplantation for alcoholic liver disease. Transplantation 2008; 86(8): 1090–1095.

11. Olthoff KM, Brown RS Jr, Delmonico FL et al. Summary report of a national conference: Evolving concepts in liver allocation in the MELD and PELD era. December 8, 2003, Washington, DC, USA. Liver Transpl 2004; 10 (10 Suppl 2): A6–A22.

12. Wai H, Stepanova M, Saab S et al. Inpa­tient economic and mortality assessment for liver transplantation: a nationwide study of the United States data from 2005 to 2009. Transplantation 2013. [In press].

13. Renz JF, Yersiz H, Reichert PR et al. Split-liver transplantation: a review. Am J Transplant 2003; 3(11): 1323–1335.

14. Shimada M, Fujii M, Morine Y et al. Living-donor liver transplantation: present status and future perspective. J Med Invest 2005; 52(1–2): 22–32.

15. Mehrabi A, Fonouni H, Müller SA et al. Current concepts in transplant surgery: liver transplantation today. Langenbecks Arch Surg 2008; 393(3): 245–260.

16. Davis CL. Kidney failure in liver transplantation: it is time for action. Am J Transplant 2006; 6(11): 2533–2534.

17. McCaughan GW, Vajdic CM. De novo malignant disease after liver transplantation? Risk and surveillance strategies. Liver Transpl 2013; doi: 10.1002/lt.23738.

Labels
Paediatric gastroenterology Gastroenterology and hepatology Surgery

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